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General NPI Number Information
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NPI Number | 1700426111
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Entity Type | Individual
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Provider Name | DEVON LEE MAZZANTI
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Gender | Female
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Dates
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Enumeration Date | 01/14/2020
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 1225 WHITEHORSE MERCERVILLE RD STE 220
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City | MERCERVILLE
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State | NJ
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Zip | 08619-3882
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Country | US
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Telephone | 609-581-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 11 CAMELLIA RD
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City | LEVITTOWN
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State | PA
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Zip | 19057-1703
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA061805
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License Number State | PA
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